| NPI | 1154148666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24814) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 17233-I) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 37396-R) | |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2026-02-20 |